Occupational Health Services

Kari-Pekka MartimoPre-Accession Advisor (PAA)

I. Good Occupational Health Practice (GOHP) guideline in Estonia

II. Developing the service provision infrastructure of OHS with widened coverage

III. Agricultural OHS, making an assessment of the OH&S situation in farms

IV. Development of indicators for functioning and status of OHS

V. Increasing awareness and disseminating information through networks

Five element objectives (EO)

• Aim was to introduce GOHP guidelines into practice in Estonia

• Activities:– Principles adopted in all activities since the

beginning of the project– GOHP guideline published in January 2004– Other published guidelines and fact sheets

supported the adoption of GOHP– Several seminars and meetings to support the

implementation of GOHP

EO I: GOHP guideline in Estonia

• Conclusions:– Guidebook was considered important even if it

needs more adaptation to Estonian system– Present legislation supports GOHP – Project supported quality improvement

required by Ministry of Social Affairs– Ethics and effectiveness of health

examinations need more consideration

EO I: GOHP guideline in Estonia

• Impact:– The wide distribution of guidebooks and

popularity of the training events together with perceived needs to develop OHS most likely lead to improvements in the OHS processes

EO I: GOHP guideline in Estonia

• Aim was to link family doctor network to the infrastructure of OHS

• Activities included– 26 days of training on work-related diseases to

1556 participants– Involvement of stakeholders through various

meetings and seminars– Study visit of OH physicians and clinical

specialists to FIOH on 16-19 March 2004

EO II: Developing OH service provision infrastructure with

widened coverage

• Conclusions:– Other specialists interested in work-

relatedness of diseases and in collaboration with OHS

– Some employers more interested in OH&S issues than required by law

– More flexibility in provision of OHS needed (e.g. SMEs, farmers, self-employed)

– Statutory obligations and possibilities of OH physicians collide

EO II: Developing OH infrastructure

• Impact:– 63 (+14) OH physicians, 197 family

physicians and other specialists and 9 agricultural experts have been informed on OHS system, its strengths and weaknesses, as well as opportunities for development and threats

EO II: Developing OH infrastructure

• Aim was to develop a model for OHS arrangements in agriculture

• Activities:– Four farms were visited on 4-5 September 2003, and

a suggestion for the OH&S model has been made– Study visit of five agricultural experts to Finland on 5-

7 November 2003– Visit to the Minister of Agriculture on 12 January

2004

EO III: Agricultural OH&S, making the assessment of the

situation in farms

• Conclusions:– Farmers’ associations have been active in

promoting OH&S– More research needed on incidence of

work accidents and work-related diseases among farmers, as well as more training and information on OH&S issues

– Collaboration between public health and OH authorities needed to expand OHS expertise to rural areas

EO III: Agricultural OHS

• Impact:– Project activities have contributed to the

initiation of development of occupational health and safety services in agriculture

– Practical aids have been produced

EO III: Agricultural OHS

• Aim was to develop models and indicators (quantitative and qualitative) for evaluation of OHS unit’s functions.

• Planned activity was to instruct OHC on indicators to collect information for the Ministry, and for self-evaluation of the units

• Several meetings and seminar focused on indicators

EO IV: Development of indicators for functioning and

status of OHS

• Conclusions:– At present, the service providers are well

documented, but too little information exist on the processes and customers of OHS in Estonia

– Registry of W-RDs makes an alternative for that of ODs

– Self-assessment of effectiveness and quality was supported with practical aids

EO IV: Development of indicators

• Impact:– Preparedness for use of indicators has

increased– Future role of Health Care Board in follow-

up of OHS?

EO IV: Development of indicators

• Aim was to increase awareness and information among interest groups in collaboration with network element

• Activities:– All meetings, seminars and training events

have distributed information on OHS– On 12 December 2003 a special seminar was

organised to the employers

EO V: Increasing awareness and disseminating information

through networks

• Conclusions:– General interest of employer and employee

organisations on OH&S issues has been modest

– Public interest increased after latest amendment of Act on OH&S and during discussions on insurance of ODs and work accidents

– OH&S issues have not been in the agenda of decision makers during the project

EO V: Increasing awareness...

• Impact:– The project has analysed the present

situation and produced material for improvement of the OH&S in Estonia

EO V: Increasing awareness...

• Amendments needed in the Act on OH&S:– Employer’s duty to provide continuous

access to OH specialist– OH services should be obligations instead

of possibilities– Inconsistencies concerning ODs/W-RDs– Good Occupational Health Practice

• Promotion as well as protection and prevention• Follow-up and evaluation at national level

Recommendation for future actions

• Incentives for the employers to improve OH&S– More responsibility for work-related ill-

health– Premiums through insurance system– Information on productivity and health and

safety at work– Adequate resources for Labour

Inspectorate

Recommendation for future actions

• Alternative models for OHS– Profit making enterprises and self-

employed do not cover peripheral regions– Large enterprises may prefer in-house OH

specialists for closer collaboration– Family physicians should get more

involved in OHS but only if adequately trained and supervised by OH specialists

– Professional independence is a challenge in every model

Recommendation for future actions

• Strong competent authority needed– Prerequisite for development of OHS– Needed for

• Training• Expert advice• Research• Information• Collaboration• For public image of OHS

Recommendation for future actions